Still Emma
by yugifrozenfan
Summary: Modern!AU. When Emma shows signs of early-onset dementia regardless of her healthy lifestyle prior, it becomes a race to find a way to subdue the disease.


**AN: I'm back again with another OUAT fanfic. After much deliberation, I decided to revive a fanfic I tried to write before scrapping it because it wasn't coming out to well. What it was was Emma gets Alzheimer's disease. This version will be somewhat the same, but with some differences. The OUAT franchise is owned by ABC Studios & Kitsis/Horowitz, LLC.**

Emma Swan was one of those people whom you'd call "healthy as a horse." Well, when you're married to one of the most world renowned doctors in the history and a cop for a living, staying fit is practically required for the job. However, lately, she began feeling a little funny and had memory issues like for example, she NEVER ate the same thing twice. At work, her typical lunch consisted of a sandwich and a salad and while she was able to register that she ate the salad, she couldn't remember eating the sandwich BEFORE she ate the salad. So, it was home for her to retrieve the sandwich she already ate.

"Swan, what the bloody hell are you doing back this early?" Killian asked when Emma flew the door open. He too was on his lunch break before heading back to his practice. Emma never went back home for lunch, she would usually just call if she forgot something.

"Did you pack me my typical lunch?"

"Yes."

"Then why did I only find a salad in my lunchbag?" Killian was stumped. Here was his wife, accusing him of changing her typical lunch. He stood there dumbfounded as she marched into their kitchen and dug out a loaf of bread. "Uh, Killian? What's my typical sandwich?" she asked.

"Lettuce, Tomato and Cheese", he answered as Emma fumbled about in the kitchen. Eventually she was able to locate the toppings, made the sandwich she just ate, kissed her perplexed husband goodbye and went back to the sheriff's station as if nothing had happened. It was almost like the exchange this morning.

Killian, being a doctor who specialized in neurodegenerative diseases, was very familiar with them. He believed that there wasn't any neurodegenerative disease that could be subdued in someway. Before his break, he had a couple whose wife had developed Parkinson's Disease visit him, saying his practice had very high marks and he had a reputation. For the wife, he had mapped out a plan that involved physical activity to regulate her shakes and physical therapy to help straighten her posture, all with the understanding that he was merely subduing the disease and not outright making it go away. Her husband had called him with glowing news saying that she was almost back to her old self. Killian stated he was glad to hear it, but told the guy to keep a realistic edge as again, what he did merely SUBDUED the disease and not outright cured his wife of it, because like most neurodegenerative diseases, although there's people and foundations trying to find them, there was literally no outright cure for them. If Emma had what he thought she had, it was trouble for both of them.

Killian knew about Alzheimer's and the genotypes involved in it. Everyone had a variant of the APOE gene in them, inheriting two copies from each parent. What made him decide to practice in the realm of neurodegenerative diseases was his brother, Liam, who had developed early-onset Alzheimer's at the tender age of just 36, which was ironic because both their parents were APOE 3/2 & 2/3 with no family history of Alzheimer's. His brother's case had broke his perception that Alzheimer's was just an old-person's disease, illustrating that one could develop it at anytime as Liam showed signs when he was 35. After he died, Killian, with the blessing of his father and in accordance with his brother's wishes, took a swab of Liam's genetic tissue and studied it, finding that even though Liam was a 3/3, he had inherited a PSEN gene from their mother, who had a parent with the disease. He thought it was amazing in that little PSEN had bypassed him and got his brother instead. Killian himself was a ⅔ and no mutated genes to cause early-onset Alzheimer's but still he needed to be sure if Emma was indeed developing Alzheimer's.

When Emma got home, Killian had a paper and pencil in front of him, trying the tried and true technique of having the suspected afflicted draw a circle. "What is this?" she asked.

"Emma, draw a circle", he merely said.

"Why?"

"Your little episode this afternoon has me convinced you're developing one of the most dreaded diseases known to man. Draw the circle", he repeated.

"Killian, you're well aware that I told you I wasn't worried. My family has Alzheimer's in them but there's the possibility that I wouldn't get it."

"I'm still not convinced." Knowing he wasn't going to drop it, Emma sat down and drew a perfect circle.

"Add the numbers." Emma did so.

"Make the clock hands say 10:14." Emma did but then she spaced out and made the clock hands say 10:30. Killian took the paper and looked at it. "Just as I suspected", he muttered to himself. He turned towards Emma, who was awaiting his verdict. "It's safe to say that you may have early-onset dementia", he stated. Emma was surprised.

"I thought the usual age of onset was 65 or higher", she stated.

"It's not. Not sure if I told you this but my brother developed early-onset Alzheimer's in his mid-30s, which was odd because his APOE genotype was 3/3 but it turned he inherited the deterministic PSEN gene for Alzheimer's from my mother. Turns out one of her parents had it", he explained.

"Killian, call me in sick tomorrow. We need to see a doctor."

"You forget you married one."

The couple sat in the waiting room of Killian's practice and the reason why they were there in the first place? Killian didn't trust the other doctors and for good reason as most, if not all, of them weren't really well-versed in neurodegenerative diseases and if they were, didn't really know how to properly treat or subdue them. While they were waiting for one of his associates to come in and check on them, Emma started to get up and move towards the door, muttering something about needing to go to work, not remembering she had Killian call her in sick. Fortunately, Killian caught this and guided her back to her seat, holding her there until the associate showed up. "Swan-Jones, Emma", he said in a thick Scottish accent. Emma held up her hand. Killian whispered to her. "That's Dr. Gold, our Alzheimer's specialist. The man's a genius." While Killian had high praise for Gold and his work, it was clear Gold still hated Killian for stealing his wife from him a while back. As Emma got up to follow him, Killian got up as well but one look from Gold buckled him back down. "You'll see her in a couple minutes, or hours. I'd suggest you head into your office, I'll page you if anything comes up", he stated. That was the problem working with Gold, he talked like he owned the joint, even though it was Killian's name on the outside of the building: Killian Jones, MD. Neurodegenerative Disease Services, it said. Killian didn't move, unsure of what to do, finally, he conceded, knowing Emma was in good hands with his team.

Emma followed Gold into the room typically used for Alzheimer's screenings and testing. "Now, Mrs. Swan-Jones, you understand that if you have early-onset Alzheimer's, there's literally nothing we can do to cure it. We can subdue it, but that's really about it. Now, Killian had told me on the phone this morning that you were having some recent blackouts in memory?"

"Yes. The first blackout was at work."

"What do you do?"

"Police Officer in Storybrooke Parish"

"Carry On."

"At lunch, I normally have a sandwich and salad. Well, I ate the sandwich already but for some reason, I thought Killian didn't pack it so I drove back home, made another sandwich and went through the motions of the routine that morning."

"When was the next blackout?"

"When I went home, he gave me the clock test screening for dementia. He said, make the clock say 10:14 but I made them say 10:30. The recent one was I forgot I was excused from work", she finished and saw Gold writing intensely on his notepad.

"Any family history of cognitive decline in general?" he asked. Emma looked perplexed.

"Uh?"

"The reason why I ask this is because there's an impairment called mild cognitive impairment that, in some cases, can actually lead to dementia down the line. It's usually due to one family member experiencing it that can lead to someone else getting it down the line." Emma nodded to show she understood what he explained.

"My grandmother had it", she stated.

"So, you do have a family history", he stated as he wrote on his notepad.

"Yes."

"APOE4 positive or negative?" Again, Emma was stumped.

"Can't you just pull up my records on your computer?"

"Technically, I could but see, only patients that are registered with us directly can have their medical records accessed from our servers. Only my boss has access to everyone's medical history, whether or not they're registered with us", he explained as he picked up his pager.

"Dr. Jones, to the Alzheimer's wing. Dr. Jones, Alzheimer's wing", he repeated into the pager before hooking it onto his belt. "Now", he turned to Emma, "APOE4 positive or negative?"

"I think I was positive."

"Positive for APOE4?"

"Yes. My mother is APOE4 positive."

"Grandmother too, probably."

"Surprisingly no. It was my grandfather who had Alzheimer's", Emma stated.

"Hmmmm."

"What?"

"Something isn't clicking here with what you're saying. Because your genotype is two numbers inherited. The one on the front is the one usually inherited from the mother, the one on the back is the father's contribution. If what you're saying is true and it was indeed your grandfather who was afflicted, your mother's APOE genotype should have been ¾. Actually, scientists are finding that the risk for indeed developing late-onset Alzheimer's is higher if you're a double 4 and you had told me it was your grandmother who had cognitive decline", Gold stated.

"Why would my mother's genotype should have been ¾?"

"We get most of our genes from our mothers anyway", Gold stated matter-of-factly. Finally, Killian came in, sporting his work scrubs.

"You wanted to see me?"

"Do you have a copy of Emma Swan-Jones' medical history?" he asked.

"Uh, yes, I do."

"Can I see it?"

"Sure, I'll get her file", Killian stated, rushing back to his office. Gold turned back to Emma.

"See what I mean? It's actually easier if you're outright registered with us. Makes things alot easier to determine how and where we can begin treatment", Gold stated as Killian came back with a copy of Emma's file and medical records. He handed the file to Gold.

"Thank you", he stated, thumbing through it. "Yep, like you said, APOE4 positive. 4/3. Works out five days a week, Police officer in Storybrooke Parish, all that jazz", he stated. "Yep, like you said, mother was APOE4 positive. Huh, how funny. It says that we're your mother's primary caregiver but you're with Whale."

"The reason why he brought me here was because he didn't trust Whale."

"Makes sense. Whale is a good doctor but sadly, he hasn't trained in neurodegenerative diseases. Now, Emma, we're going to do some recall tests of the verbal kind."

"Meaning?"

"It's to test your memory functions. Now, repeat after me: The Rain In Spain Stays Mainly In The Plain." Emma wasn't sure what kind of a game Gold was playing, even after he assured her this was merely a test to see if she could remember the exact sentence and repeat it back to him.

"The Rain in Spain stays mainly, how did the rest of it go? I forgot," Emma was mentally kicking herself now as anyone who had seen My Fair Lady as many times as she had would have deadlocked the line in their memory. Gold didn't seem to care that she missed the last portion.

"It's all right. Now, here's a harder one: The Pellet With The Poison Has The Flagon With The Dragon. The Chalice From The Palace Has The Brew That Is True", Gold stated, giving Emma one of the best known tongue-twisters known to man.

"The Pellet With The Poison Has The Flagon With The Dragon. The Chalice From The Palace Has The Brew That Is True", Emma stated, surprised that she didn't forget a single word. They did a few more tests and she aced most of them. Gold took note that Emma's memory decline was small and she was only in the spell stage and not full-on confusal, at least not yet, knowing Hook would have his hands full if she EVER got to that stage. Therefore, he would have to get Emma on a program that will help her maintain her cognitive abilities well into her old age, and by extension, her mother's. Besides, Emma was only 31 years old, she had her whole life ahead of her!

"Speaking of which, how IS your mother?" Gold asked.

"Fine, although she has moments of fading. But, she's a tough cookie", Emma stated.

"Well, that's good. Everyone says Alzheimer's disease and dementia are incurable and can't be reversed. Well, I say they're wrong", Gold proclaimed. "It CAN be prevented if caught early enough and with the right modifications to diet as well as physical exercise, you'll be as healthy as a horse."

"That's what I thought", Emma mumbled, noting the irony of that her mother promoted healthy diet and exercise in an effort to try and beat the Alzheimer's that took both grandparents and as an added consequence, their family had a reputation of being the healthiest families on the block and in the end, both showed signs of early-onset regardless, the only one who was safe was her father, who had no Alzheimer's in his family history or genes. As a matter of fact, her father was aware that her mother had a history of Alzheimer's in her family. Gold continued.

"Now, Emma, there's a special protocol treatment that is designed to reverse cognitive decline. However, there's one catch: You have to stay on this program to ensure continued progress but it should be easy for you because you're already healthy enough as it is. Considering that you eat healthy and exercise a lot means that your symptoms are not as 'potent' as they say. Go off the program for whatever reason and your symptoms come back, maybe even more severe than before. How many times a week do you eat out?"

"Not often. Only on occasion", Emma stated

"Good. Keep it that way. Now, how much processed foods do you eat?"

"I'm a vegetarian."

"What kind? There's multiple kinds of vegetarian diets out there."

"Pollotarian."

"Ah, the one that allows poultry. Continue as you were but make an allowance for fish and some dairy products. Now, how much fruits and vegetables do you consume daily?"

"Quite a bit."

"As you were", Gold finished mapping out Emma's plan to reverse her cognitive decline so her issues didn't progress to something worse. "You have your whole life ahead of you, don't squander it", he stated as he signed the paper. "Dr. Jones, Alzheimer's wing", he paged and in a flash, Killian showed up again.

"This better be quick, I'm with a patient", he stated. Gold held out a paper.

"This here is Emma's RECODE plan. Basically, the reason why she's still in the 'spell' stage is because again, her healthy eating habits and her exercise habits have her decline still at a point where she can be treated and subdued. I, as head of the Alzheimer's wing, already signed it. You and her PCP have to sign it as well to make it official. The reason why her PCP has to sign as well is because this visit and treatment was under-the-table. If she was actually registered, it wouldn't be", he explained. Killian took the paper, read it and signed it right then and there. Emma shook hands with Gold and thanked him for his help, but noticed that Gold didn't shake hands with Killian, again, because of that grudge. Killian had Emma wait in the room while he finished up with his patient. When he did, he came for her and they left the office and got into his car.

"When he signed my treatment plan, he told me I had my whole life ahead of me and not to squander it? What did he mean?" Killian looked at her.

"I didn't steal his wife. She divorced him because she felt he was too much of a workaholic. Basically, he's kicking himself for not spending more time with his family when he should have been. If this tells you something, I usually open the practice at 9:00am and close it at 10:00pm, if not later. He's in by 8:00am and doesn't leave until 11:00pm", Killian explained as they drove home. He had excused Emma for the day so now, the next step was to get Emma's Primary Care Provider, Dr. Whale, to sign off on the plan as well. Fortunately, once Whale was aware of what Emma had, he agreed to the treatment plan and signed off on it, although the only thing he was leary about was the coconut oil. Killian had to explain that coconut oil helps improve brain function and he actually endorsed the usage of it to his personal patients.

Emma's treatment plan for her ReCODE was the following:

This morning, at 10:30am, the Patient, Emma Swan-Jones, came in complaining of memory spells, thinking it was a sign of early-onset dementia. She has a family history of cognitive decline on her mother's side of the family, her grandfather had Alzheimer's and her grandmother had cognitive decline. However, she was still in the "spell stage" and had been healthy her entire life. As we discovered this actually migrated her spells, the following plan was put in place to treat her:

She continues her vegetarian Poultry diet, but she must add fish and white milk for calcium. It is also recommended she use coconut oil for further elevation

Continue to exercise

For mental stamina, she must do 5 crossword puzzles or read

Consume fruits and vegetables

Take vitamins and medication for memory (prescribed by PCP, Dr. Whale): As she's still in the "light stage", the following medication is recommended for prescription: Aricept, Exelon and Razadyne

If she follows those five steps, she should be back to the way she was before her signs began to appear.

Signed: Dr. Robert Gold, Alzheimer's specialist, Dr. Killian Jones (Husband of Patient and owner of the practice), Dr. Victor Whale (Primary Care Provider).

"Looks good", Killian stated. "But, it should be started immediately", he added. Emma offered no objections to starting the plan immediately but Killian was wondering if how would the plan affect that trip they've been talking about taking. Gold had warned them that if they go off the plan for any reason whatsoever (ie: Emma gets sick), Emma's memory spells would return, maybe even more severe than before. Killian was also aware that Gold told him he was not surprised Emma was falling to younger-onset dementia as a study found out that women were more susceptible to developing it but that didn't mean Killian was out the woods just yet, due to his own history of the disease in his mother and his brother, meaning he, too, could be next.

Whatever the reason, they took the trip anyway while still following the treatment plan to the letter, except that on the day they came back, Killian had forgotten to give Emma her daily pills and thus, she had left her keys in their car, not realizing it until 6:30pm. Fortunately, the time they came back was perfect because Gold had called while they were gone, requesting a follow-up appointment after a couple weeks on the program, as was customary, which is where we find them now in the room.

"So, Emma, how are you feeling?" Gold asked.

"Better. My spells are almost non-existent, minus the one I had when we got back from our trip where I forgot my daily pill intake."

"We were rushing to get back", Killian added sheepishly.

"Now, we saw your mother in the interim and got her on a modified version of this program so she should be fine in the long run. The reason we do a follow-up is so that we can see if you're (A. responding well to the program or (B. your body is rejecting it. The B usually happens when you're diagnosed fairly late, which is, sadly, most cases. But, again, medical technologies had advanced far enough to where we can catch these things now. It looks like you are responding well to the treatment plan", Gold stated before Emma was whisked away for scanning and tests to confirm it.

It turned out that the scans were positive and showed tremendous amount of improvement and the recall tests were showing the same results. However, did this mean she was cured completely?

"So, does this mean, she's cured?" Killian asked, hopefully.

"Not exactly. See, these ReCODE plans only allow people to maintain their cognitive abilities while in the throes of the disease. Hopefully, there will come a time where we can tell patients with Alzheimer's or dementia, 'you are cured completely' but we only have these programs to help us", Gold said. Well, it was better than nothing because Emma was still Emma, disease or no disease.

 **AN: That's it! That's it! I tried to do some research on the effects of Alzheimer's in a person who was otherwise very healthy, as well as the standard age of someone with early-onset Alzheimer's. I tried to make the disease and Emma's struggle with it as realistic as possible, which explains the ending. The anticode to "leaving the keys in the car in a haze" was taken from a story about someone who was on a form of a ReCODE program, goes off it because he took a trip, and then finds out he left the keys in his car. I did attempt a version of this story before but abandoned it because it wasn't coming together but hopefully, this version will be better than what I initially had in mind. R &R!**


End file.
